Chemotherapy involves taking certain anti-cancer drugs by mouth or through a vein. Because these drugs enter the bloodstream and affect all areas of the body, they are particularly effective in cases where the cancer has spread beyond the esophagus.
Chemotherapy may be the primary treatment for esophageal cancer, or it may be used in addition to surgery. As a primary treatment, chemotherapy will not cure the disease unless it is used in combination with radiation therapy, or even surgery in some instances.
Types of Chemotherapy Treatments
Chemotherapy is used in three ways for the treatment of esophageal cancer.
It may be applied as palliative therapy, the objective being to relieve symptoms such as dysphagia. This is usually done in cases of advanced cancer.
It may be used as preoperative therapy, the goal being to reduce the size of the tumor so that there may be a more complete removal through surgery. The use of preoperative chemotherapy, however, is still being evaluated by various studies. It is not considered standard treatment.
Finally, chemotherapy may be used together with radiation therapy to shrink the cancer. This is known as chemoradiotherapy. This approach is also sometimes used before surgery. It has not been proven, however, that undergoing chemoradiotherapy is better than having surgery alone. Nevertheless, it is occasionally used for those patients who cannot undergo surgery.
Chemotherapy Drugs
The chemotherapy drugs for the treatment of esophageal cancer include: bleomycin, cisplatin, doxorubicin, 5-fluorouracil, irinotecan, mitomycin, methotrexate, paclitaxel, topotecan, and vinorelbine.
Medical research suggests that 10% to 40% of patients respond favorably to these drugs, with their tumors shrinking significantly. Combinations of these chemotherapy drugs also result in favorable responses from 17% to 50% of patients who are in the advanced stage of the disease.
It should be noted that the effects of chemotherapy, when it is given alone, are temporary. According to recent studies, using chemotherapy in combination with radiation therapy is more effective in the treatment of early-stage esophageal cancer.
Side Effects of Chemotherapy
Chemotherapy drugs often attack rapidly dividing cells, such as cancer cells. Some normal cells, however, also divide rapidly. Chemotherapy drugs make no distinction between the two. The destruction of both cancer cells and normal cells often leads to uncomfortable side effects.
Among the more serious side effects are low blood cell counts, resulting from the damage caused by chemotherapy drugs to the bone marrow’s blood-producing cells.
Low white blood cell counts could increase a person’s chances of infection even from minor injuries and cuts. Low red blood cell counts could result in shortness of breath or fatigue. A shortage of blood platelets, on the other hand, could lead to bleeding or bruising even from minor injuries.
Other side effects include nausea, vomiting, and hair loss.
Most side effects cease once chemotherapy is stopped. There are also strategies and medications to relieve these side effects, such as taking drugs to reduce the incidence of nausea and vomiting.
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Reviewed by:
Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)
Medical Director
The Cancer Information Network
Date Modified: 06/10/04
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